Trial reportThe American journal of medicine2021
Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial.
Trial report in The American journal of medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Effect of egg consumption on circulating choline, betaine, and trimethylamine n-oxide in adults: a systematic review and meta-analysis of randomized controlled trials.Nutrition journal · 2025Pooled it
- The Impact of Egg Consumption on Gastrointestinal Health: A Systematic Literature Review and Meta-Analysis.Nutrients · 2025Pooled it
- Impacts of intestinal microbiota metabolite trimethylamine N-oxide on cardiovascular disease: a bibliometric analysis.Frontiers in microbiology · 2024Pooled it
- Comparison between Egg Intake versus Choline Supplementation on Gut Microbiota and Plasma Carotenoids in Subjects with Metabolic Syndrome.Nutrients · 2022Trial
- Review
- The Gut-Heart Axis in Cardiovascular Disease: Microbial Metabolites, Mediterranean and Traditional Turkish Dietary Patterns, and Personalized Medicine.International journal of molecular sciences · 2026Review
- The Gut-Brain Axis in Fetal Alcohol Spectrum Disorder (FASD): Why the Gut Shapes Behavior, Depression, and Self-Injurious Behavior in Children with Prenatal Alcohol Exposure-A Narrative Review with a Proposal for Staged Nutritional and Microbiological Intervention.Journal of clinical medicine · 2026Review
- Trimethylamine N-oxide in exercise physiology: a gut microbiota-derived signal linking metabolic stress, redox balance and cardiometabolic health.European journal of applied physiology · 2026Review
- The essential role of hydrogen gas recycling by gut microbes in reducing deuterium load in host mitochondria: is trimethylamine oxide a deuterium sensor?Metabolomics : Official journal of the Metabolomic Society · 2026Review
- [Mechanisms of gutZhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026Review
- The gut-heart axis in coronary artery disease: a scoping and narrative review of sex-based microbial and metabolic disparities.Biology of sex differences · 2026Article
- Gut microbiota and atrial cardiomyopathy.Frontiers in cardiovascular medicine · 2025Review
- TrimethylamineCirculation. Heart failure · 2024Observational
- An inverse association of dietary choline with atherosclerotic cardiovascular disease among US adults: a cross-sectional NHANES analysis.BMC public health · 2024Article
- The dietary source of trimethylamine N-oxide and clinical outcomes: an unexpected liaison.Clinical kidney journal · 2023Review
- Trimethylamine N-Oxide as a Potential Biomarker for Cardiovascular Disease: Its Association with Dietary Sources of Trimethylamine N-Oxide and Microbiota.The Eurasian journal of medicine · 2023Article
- Eggs: Healthy or Risky? A Review of Evidence from High Quality Studies on Hen's Eggs.Nutrients · 2023Review
- Gut Failure: A Review of the Pathophysiology and Therapeutic Potentials in the Gut-Heart Axis.Journal of clinical medicine · 2023Review
- Two distinct gut microbial pathways contribute to meta-organismal production of phenylacetylglutamine with links to cardiovascular disease.Cell host & microbe · 2023Article
- Choline - a scoping review for Nordic Nutrition Recommendations 2023.Food & nutrition research · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundCholine is a dietary precursor to the gut microbial generation of the prothrombotic and proatherogenic metabolite trimethylamine-N-oxide (TMAO). Eggs are rich in choline, yet the impact of habitual egg consumption on TMAO levels and platelet function in human subjects remains unclear.
methodsHealthy volunteers (41% male, 81% Caucasian, median age 28 years) with normal renal function (estimated glomerular filtration rate >60) were recruited and assigned to 1 of 5 daily interventions for 4 weeks: 1) hardboiled eggs (n = 18); 2) choline bitartrate supplements (n = 20); 3) hardboiled eggs + choline bitartrate supplements (n = 16); 4) egg whites + choline bitartrate supplements (n = 18); 5) phosphatidylcholine supplements (n = 10). Fasting blood and urine samples were collected for quantification of TMAO, its precursors, and platelet aggregometry.
resultsParticipants' plasma TMAO levels increased significantly in all 3 intervention arms containing choline bitartrate (all P < .0001), but daily ingestion of 4 large eggs (P = .28) or phosphatidylcholine supplements (P = .27) failed to increase plasma TMAO levels. Platelet reactivity also significantly increased in the 3 intervention arms containing choline bitartrate (all P < .01), but not with eggs (P = .10) or phosphatidylcholine supplements (P = .79).
conclusionsDespite high choline content in egg yolks, healthy participants consuming 4 eggs daily showed no significant increase in TMAO or platelet reactivity. However, choline bitartrate supplements providing comparable total choline raised both TMAO and platelet reactivity, demonstrating that the form and source of dietary choline differentially contributes to systemic TMAO levels and platelet responsiveness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.